Dolore cervicale e allenamento
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La cervicale nel fitness è da sempre un argomento complesso. Capita sovente di ricevere clienti che lamentano dolore cervicale e che non sanno come comportarsi per risolvere il problema.
Il rachide cervicale è composto da 7 vertebre e possiamo dividerlo per comodità in parte alta e parte bassa. La protrazione del capo (collo e mento in avanti con vertebre inclinate in avanti) è determinato da un movimento di flessione della cervicale bassa e di estensione della cervicale alta. La retrazione del capo (testa e collo indietro con vertebre verticali) è determinata da un movimento di estensione della cervicale bassa e di flessione di quella alta.
Con l’avanzare dell’età lo spazio tra una vertebra e l’altra può diminuire e questo può creare problemi. Il rachide garantisce i movimenti di flessione, inclinazione e rotazione. Delle volte questi movimenti sono limitati dal dolore o dalla rigidità muscolare.
Molte volte il dolore è semplicemente causato da una debolezza dei muscoli e quindi è sufficiente rinforzare. Ora, conoscere il nome e le funzioni di ogni muscolo del collo e del capo non ci interessa in questa sede, quello che ci interessa è sapere come comportarci, come rinforzare e cosa fare per sconfiggere il dolore. I soggetti più a rischio sono le donne sopra i 40 anni.
“Ho la cervicale”, quante volte lo abbiamo sentito, ma vuol dire tutto e niente, è possibile avere una alterazione posturale che però non causa dolore, oppure è possibile avere un’alterazione che ne causa parecchio. E’ possibile avere i muscoli deboli e quindi necessità di rinforzare, è possibile avere un dolore ad intermittenza dovuto a sovraccarico muscolare. Il dolore può essere più irradiato e ampio e derivare anche da una radice nervosa. Insomma è da valutare caso per caso.
Nel 10% dei casi il dolore cervicale è cronico, persistente. Nel 90% dei casi in meno di 3 mesi si avrà una risoluzione spontanea, e quì dobbiamo intervenire per far sì che non accada più. La presenza di artrosi, protusioni o ernie non è sempre causa del dolore stesso! Oppure spesso si “incolpa” un evento passato senza prove certe, “ho avuto un incidente 5 anni fa”. La verità è che non ci sono evidenze scientifiche in grado di correlare direttamente alcune degenerazioni o eventi con i sintomi cervicali.
Cosa fare in caso di dolore cervicale
Se il dolore è molto intenso e costante:
-E’ consigliabile fermarsi dagli allenamenti e aspettare 7-10 giorni in modo che l’infiammazione passi.
-Cercare di non rimanere immobili ma muovere il collo. L’immobilizzazione favorisce la debolezza muscolare pertanto va evitata.
-Riprendere gli allenamenti e lavorare sul non dolore, fare esercizi che non ci danno fastidio. Evitare gli squat pesanti con bilanciere, per non sovraccaricare la zona dolente, preferire i manubri (se non c’è stiramento ai trapezi). Curare lo stretching e le posture non solo del collo ma anche di tutta la schiena!
-Piano piano ritornare alla normalità evitando sempre gli esercizi che causano più fastidio.
Evitare gli antidolorifici in quanto nascondono solamente il problema, non lo risolvono! Sentire male facendo un certo movimento invece è un segno da rispettare che ci dà il nostro corpo “hey non fare questo!”. Ovviamente consiglio di andare da un bravo fisioterapista, il personal trainer poi collaborerà con lui per farvi tornare al 100%. Non inventiamoci dottori è importante!
Protrazione del capo
In caso di protrazione del capo (collo e testa in avanti) la causa potrebbe essere la postura prolungata che si mantiene quotidianamente, soprattutto può accadere a chi lavora al PC. Il rachide cervicale è strettamente collegato al rachide toracico. Molte volte in caso di iper-cifosi notiamo anche un’alterazione posturale cervicale con il capo protratto in avanti. Mantenendo la schiena curva in avanti, per far sì che il capo guardi in avanti il corpo reagisce portando in avanti il collo, è un’alterazione naturale.
La “gobba cifotica” causa grande stress che porta a rigidità muscolare e rischio articolare, favorendo lesioni discali. I muscoli del collo saranno deboli e i muscoli scapolari in sovraccarico. In questi casi notiamo movimenti involontari del collo anche quando si eseguono esercizi di gambe o braccia.
Spesso ai clienti manca anche la consapevolezza del proprio corpo, lavorare su questo aspetto è importante. Chiudere le scapole, retrarre o protrarre il collo, sollevare le braccia senza compensare con il collo, retroversione e antiversione del bacino, sono tutti movimenti importanti da imparare.
Ci sono esercizi come il rematore al TRX, l’hip Thrust, i piegamenti, i plank che richiedono una buona forza cervicale, e in caso di debolezza il cliente può avvertire fastidio. Dobbiamo valutare se toglierli o meno, in base all’intensità del dolore. Dobbiamo capire che i muscoli stanno lavorando quindi può essere un buon rinforzo ma non deve essere eccessivo, qualora lo fosse meglio sospenderli. Il crunch è un esercizio che sconsiglio, meglio i plank con le sue varianti, più efficaci e meno traumatici per il rachide. Negli esercizi da sdraiati l’ideale sarebbe mettere un rialzo dietro al capo, un asciugamano oppure un cuscinetto. L’altezza del cuscinetto deve essere ideale a riallineare il capo, quindi dipende dal grado di cifosi.
Vi riporto un video con una serie di esercizi di mobilizzazione e di rinforzo da fare al termine dell’allenamento (oppure diventa proprio l’allenamento in caso di problemi più gravi). VIDEO
Contrattura o allungamento
Ci sono delle differenze. Il dolore può essere provocato da una muscolatura troppo contratta, oppure da una muscolatura del trapezio allungata (non è uno stiramento muscolare). In comune abbiamo il dolore e la ridotta mobilità, la causa è differente. In caso di contrattura abbiamo un sovraccarico funzionale, nel giro di pochi giorni dovrebbe scomparire il dolore, in caso di eccessivo allungamento del trapezio il dolore è molto più duraturo (mesi).
–Contrattura: dolore evocato durante la contrazione del muscolo. Preferire i manubri lungo i fianchi, evitando il bilanciere sulle spalle. Evitare le scrollate, il lento manubri e gli esercizi che portano in contrazione il trapezio. Curare lo stretching, massaggi con rullo e palline e posture.
–Allungamento: riduzione del dolore durante l’accorciamento. Evitare i manubri lungo i fianchi, preferire il bilanciere sulle spalle in quanto porta il trapezio e i muscoli scapolari in accorciamento. Preferire gli esercizi come spider curl al posto del curl in piedi, preferire le alzate nubret al posto delle alzate laterali. Inserire esercizi di rinforzo per il trapezio, come scrollate a braccia distese in alto e lento manubri. Evitare lo stretching eccessivo!
Come sempre in questi casi particolari è importante la collaborazione tra personal trainer e fisioterapista.
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